Provider Demographics
NPI:1316091325
Name:TAMEZ, ERNESTO M JR (PA)
Entity type:Individual
Prefix:
First Name:ERNESTO
Middle Name:M
Last Name:TAMEZ
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PHYSICIANS PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-5204
Mailing Address - Country:US
Mailing Address - Phone:910-895-1989
Mailing Address - Fax:910-895-1988
Practice Address - Street 1:104 PHYSICIANS PARK DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-5204
Practice Address - Country:US
Practice Address - Phone:910-895-1989
Practice Address - Fax:910-895-1988
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03097363AM0700X
NC0010-09276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical